Teen mental health: Signs of the times

In an effort to raise awareness, Record editor Terry Farrell recently had an in-depth discussion with a couple of St. Joseph’s Hospital’s most respected authorities in the field of teen distress. Vicki Sheppard, clinical nurse leader for crisis and SANE (sexual assault nurse examiner) services and David Hext, outreach counsellor for adolescent outpatient services, have made careers of helping teens with mental health issues. The following is the first of a two-part series.

The signs are out there: Lack of appetite; lack of hygiene; sleep disturbance. This is more than just “being a teen”.

Teenagers are struggling these days with mental health. Are they struggling more than their parents did at their age? That’s debatable. One thing that is not, however, is the anxiety associated with teenagers now.

Vicki Sheppard, clinical nurse leader for crisis and SANE (sexual assault nurse examiner) services and David Hext, outreach counsellor for adolescent outpatient services, agree that the level of anxiety among this generation of teens is higher than any previous generation they have seen.

“The number of anxious kids I see is through the roof,” said Sheppard. “They don’t sleep properly, they don’t eat properly, but the attitude about it seems so blasé.”

She said the anxiety is often a result of their home life.

“I see so many families these days where the parents are highly anxious, highly stressed, and that is so catchy. Kids just catch that.”

“A psychiatrist friend of mine said years ago that with any child mental health agency, 60 to 70 per cent of their clientele will have anxiety issues,” said Hext. “Thirty per cent will be depression and 10 per cent other things, like substance abuse, but the majority is anxiety.”

When asked for possible explanations, they both looked down at their smartphones.

“These,” said Hext, picking up his phone. “The one thing I have noticed is that there is no down time for kids anymore. I think a lot of them are exhausted. The drama of school – who`s going out with who, who is seeing who, and whatever – that used to end at three o’clock. Now it ramps up at three o’clock.

“There’s just no rest. Sometimes kids can’t go to sleep with their phones turned off. They might miss something.”

Importance of nutrition

Numerous studies indicate that good nutrition is essential for our mental health and that a number of mental health conditions may be influenced by dietary factors, and yet fewer and fewer schools are being built with cafeterias. Solving the nutrition issue is not as easy as handing the child $20 for lunch. The hot, nutritious lunches once available at most schools are becoming a thing of the past.

“Vanier has one, but Isfeld, our most expensive school, does not,” said Hext. “Highland does not have one. None of the junior schools have cafeterias. So we pay a lot of lip service to nutrition, but …”

Hext said he often sees clients who claim to be depressed, but due to the lack of proper nutrition, an accurate diagnosis is not possible.

“I will be sent a girl by a counsellor who says ‘I think this girl is depressed’ and I talk to her about her lifestyle and say ‘you’re not drinking enough water, you’re not eating at the proper times, you’re not sleeping enough. How can I tell if you are depressed?’ I can’t.”

“For me, so often I feel like I am taking people back to the basics,” said Sheppard. “You need to sleep, you need to eat by the clock. You need to take care of yourself because everything else goes out the window. Yes, you’re depressed, yes, you’re anxious, yes you’re all those things, but how do we know what’s going on until you take care of the basics.”

One of the most basic of the basics is nutrition. What is the solution?

“Send your kids to school with a lunch,” said Hext. “Why not? At least that way you know you are supplying your child with nutrition. And it also sends the message to your child that you care. That’s important.”

Social media is another avenue no previous generation had access to, regarding information, and support, or non-support from peers.

“Teens on, as an example, Facebook, saying things like ‘I’m going to kill myself now’, or ‘I’m cutting now – here’s a picture of me cutting’. There’s a lot of that going on,” said Sheppard.

“There is a lot of positive use of social media, but there is equal amount of negative use,” added Hext. “There’s something very self involved about social media. This is ‘my website’. Look at ‘my photos’. Selfies – they seem to be rampant nowadays. It’s like there’s an absence of shame, perhaps.”

The adverse effects of the immediacy of social media have been well documented. Many people, particularly teens, will post comments, or pictures, without considering the consequences. Those consequences can be dire.

“Everybody wants instant gratification. ‘I don’t feel good. I want to feel better.’ So they post something, maybe a picture of them partially naked, in their underwear. They don’t seriously consider what they are doing before thinking about it. Suddenly it’s out there and they are humiliated, embarrassed.

“There’s just not a lot of understanding as to how quickly it can get out there.”

Both Hext and Sheppard agree that there is more talk about mental health, and more openness towards it than there ever has been. But there is a danger with that as well.

“The kids nowadays know a lot more of the psychiatric lingo than they ever used to,” said Hext. “You will often hear them say ‘oh, it’s just my Turret’s’ or ‘it’s just my ADHD’, or ‘I’m suffering from depression, my mom had depression and I have it too.’ There are still some out there that are uncomfortable talking about mental illness as a whole, but there’s a lot more talk out there than there used to be. There is much less stigma than there used to be.”

There is more help, as well. School boards are doing much more than in previous generations.

“When I was going to school, it was just assumed that families were taking care of such things,” Hext said. “You’d go to a career counsellor (in school) and they would say ‘go get a career’, but they weren’t every helpful. Now counsellors do a lot; they are really busy.”

Be a parent, then a friend

The key to addressing mental health issues with your child is to approach them directly.

But it’s just not communication; it’s communication as an authority figure.

Parenting has changed from generations past in that there is an appeal for parents to be “friends” with their children. That can be a dangerous line.

“I hear, especially with single parents, moms say ‘I don’t know what’s wrong with her. She’s just so angry. She was my best friend.’ And I say ‘whoa, now we have a problem. She’s not supposed to be your best friend,’” said Hext.

“It’s really hard to say no when it’s your friend. Parents need to lay boundaries. Best friends don’t have the same boundaries.”

Re-setting boundaries can be difficult, but it is possible.

“”When you begin to set limits and boundaries, you can expect the behaviour to escalate, initially,” said Sheppard. “But of a person sticks to it, that (resistance) will go away.”

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The teen mental health series continues next week with a look at self injury and suicidal ideation.